Breastfeeding premature babies in the NICU

0-3 months

Breastmilk is the ideal food for your baby. But if your baby was very premature, it might be weeks before he can suckle. You can express your breastmilk so your premature baby can have it by tube or bottle until he’s ready to feed at your breast.

Breastmilk for premature babies

Breastmilk is exactly suited to your baby’s nutritional needs. It also protects her from infection and illnesses.

If you give birth prematurely, your milk will be slightly different from full-term milk. This is because your baby’s needs are different from those of a full-term baby.

Because premature babies need more proteins for growth than full-term babies, your colostrum will have more protein than the colostrum of full-term mothers.

You’ll also have more of an enzyme called lysozyme. Lysozyme attacks certain bacteria and helps protect your baby from infections. And your breastmilk will have more fat and less lactose, because premature babies find lactose hard to digest.

Expressing breastmilk for premature babies

If your baby is late preterm (36-37 weeks), he’ll probably be able to suckle breastmilk from your breast. But if your baby is younger, it might be weeks before he’s able to breastfeed fully.

During this time your baby can still have your breastmilk, either through a tube that runs from her nose down into her stomach or by bottle or cup.

You’ll need to express your breastmilk either by hand or by using a hand-held or electric pump. It’s helpful to express breastmilk soon after your baby’s birth and then to express every 2-4 hours to keep your supply up.

Like breastfeeding, expressing breastmilk is a skill you have to learn. If you have trouble getting the hang of it, the midwives, nurses or the hospital’s lactation consultant will be able to help you. Don’t be afraid to ask for help.

Breastmilk is the best food for your baby. If it works for you, expressing breastmilk for your premature baby is also something that only you can do at the very time you might be feeling like there’s nothing you can do. Our guide to expressing and storing breastmilk can help you get started.

Premature babies starting to suckle

Before your premature baby can suckle, kangaroo care can be a great way to help him get comfortable with skin-to-skin contact. It can also help you to produce more milk.

When your premature baby is ready to start breastfeeding, you might find that progress can be quite slow, especially if your baby was born very early or is very sick. Feeding is a complicated skill, and premature babies get tired very quickly. During this learning time, your baby might suckle only a very small amount of milk from your breast, with the rest fed by tube.

It can take some premature babies a while to get the hang of breastfeeding.

Donor milkIf you can’t breastfeed or express, you might be able to give your baby donated breastmilk. This might be possible if the hospital where you gave birth has a milk bank.

Donated breastmilk is pasteurised before it’s given to your baby. The pasteurisation process does reduce some of the nutrients and the properties of the milk that protect against infection, but the milk still has enough to do your baby good.

Formula milk
There might be times when your baby’s doctor suggests that your baby needs feeds of infant formula. There are special formulas for premature babies.

If you need to give your premature baby formula as well as breastmilk, it doesn’t mean you should stop expressing or breastfeeding altogether. Many babies have a combination of breastmilk and formula, and any amount of breastmilk has benefits.

In the end, it’s your choice whether to breastfeed or use formula. You can decide based on your own circumstances. Whatever feeding method you choose, you can still be there for your baby and comfort her.

Breastfeeding and your premature baby’s development

If you can’t breastfeed for whatever reason, express breastmilk for as long as you can and give it to your baby by bottle. Breastfeeding helps baby development, so it’s good to breastfeed if you can.

Some mothers of premature babies have problems with their milk supply and can’t feed their baby breastmilk. If that’s the case, it’s comforting to know that today’s milk formulas provide the basic building blocks for growth.

Breastfeeding is linked to improved thinking and learning development and fewer behaviour problems in children aged five years. But if you have difficulty with breastfeeding, keep in mind that warm and loving parent-child relationships have a very positive influence on development too.

This article was developed in collaboration with Dr Carol Newnham, Parent-Infant Research Institute, and Professor Jeanette Milgrom, University of Melbourne and Parent-Infant Research Institute.

Raising Children Network is supported by the Australian Government. Member organisations are the Parenting Research Centre and the Murdoch Childrens Research Institute with The Royal Children’s Hospital Centre for Community Child Health.